Liver transplantation at the University of Texas Health Science Center/University Hospital in San Antonio.

Liver transplantation is the only potentially curative treatment for patients with end-stage liver disease. An extensive medical and psychosocial evaluation is performed in an attempt to determine which patients are likely to have acceptable outcomes with the procedure. The limited number of donor livers relative to patients that need a liver transplant, and the occurrence of significant deaths in the waiting group, has motivated many transplant programs to agree to put living donors at risk to help solve this problem. Other complex operative techniques such as splitting livers for use in 2 patients have improved the organ availability for pediatric and adult patients. Growth of a liver transplant program from a small program to a large program necessitates institutional, hospital capacity and infrastructure support at many levels to be successful. This requires a strong partnership between the physicians and the hospital system. 1. The University of Texas Health Science Center/University Hospital in San Antonio has performed 610 liver transplants over ten years. Overall one- and 5-year patient survival rates were 88% and 75%, respectively, despite transplanting a relatively advanced population of patients based on MELD scoring. 2. The most frequent indication for liver transplantation was hepatitis C (52% of patients) and the one-, 5-, and 10-year survival rates for transplantation for hepatitis C was equivalent to survival rates after liver transplantation for other indications, despite significant recurrent hepatitis C liver injury. 3. Technical refinements have decreased operative times and immunosuppressive advances have decreased the side effects while maintaining excellent outcomes. Veno-venous bypass and the placement of biliary T-tubes are not currently used. Standard immunosuppression is lower dose Prograf, Cellcept and steroids with Cellcept being weaned off at 3 months and steroids weaned off by one year. 4. Strategies to increase the donor pool including the use of older donors, the use of steatotic livers, the use of split livers and living liver donors for children and adults are all being used successfully at UTHSCSA.